HHS Public Access Author manuscript Author Manuscript
Scand J Work Environ Health. Author manuscript; available in PMC 2016 July 18. Published in final edited form as: Scand J Work Environ Health. 2016 July 1; 42(4): 329–337. doi:10.5271/sjweh.3569.
Improving safety climate through a communication and recognition program for construction: a mixed-methods study Emily H Sparer, ScD1,2, Paul J Catalano, ScD3,4, Robert F Herrick, ScD1, and Jack T Dennerlein, PhD1,5 1Department
of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA,
USA
Author Manuscript
2Department
of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
3Department
of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
4Department
of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston,
MA, USA 5Department
of Physical Therapy, Movement, and Rehabilitation Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
Abstract Author Manuscript
Objectives—This study aimed to evaluate the efficacy of a safety communication and recognition program (B-SAFE), designed to encourage improvement of physical working conditions and hazard reduction in construction. Methods—A matched pair cluster randomized controlled trial was conducted on eight worksites (four received the B-SAFE intervention, four served as control sites) for approximately five months per site. Pre- and post-exposure worker surveys were collected at all sites (N=615, pre-exposure response rate of 74%, post-exposure response rate of 88%). Multi-level mixed-effect regression models evaluated the effect of B-SAFE on safety climate as assessed from surveys. Focus groups (N=6–8 workers/site) were conducted following data collection. Transcripts were coded and analyzed for thematic content using Atlas.ti (version 6).
Author Manuscript
Results—The mean safety climate score at intervention sites, as measured on a 0–50 point scale, increased 0.5 points (1%) between pre- and post-B-SAFE exposure, compared to control sites that decreased 0.8 points (1.6%). The intervention effect size was 1.64 (3.28%) (Pvalue=0.01) when adjusted for month the worker started on-site, total length of time on-site, as well as individual characteristics (trade, title, age, and race/ethnicity). At intervention sites, workers noted increased levels of safety awareness, communication, and teamwork compared to control sites.
Correspondence to: Jack Dennerlein, Department of Physical Therapy, Movement, and Rehabilitation Sciences, Bouvé College of Health Sciences, Northeastern University, 301 Robinson Hall, 360 Huntington Ave, Boston, MA 02115, USA. [email protected].
Sparer et al.
Page 2
Author Manuscript
Conclusions—B-SAFE led to many positive changes, including an improvement in safety climate, awareness, teambuilding, and communication. B-SAFE was a simple intervention that engaged workers through effective communication infrastructures and had a significant, positive effect on worksite safety. Keywords B-SAFE; communication; construction; construction industry; construction worker; hazard control; health and safety; mixed method; mixed-method study; recognition; safety; safety climate; safety incentive program; safety intervention
Author Manuscript
Recent decades have brought large improvements to health and safety conditions in the construction industry, yet the number of fatal and non-fatal injuries remains extremely high (1). To combat this, some employers have implemented safety incentive programs, such as those that use injury-based safety performance metrics to evaluate overall worksite safety and reward workers. However, these lagging indicator-based programs may discriminate against injured workers (2) and may reduce injury reporting (3, 4).
Author Manuscript
As an alternative, programs could rely instead on leading indicators of safety, such as hazard control and other root causes of injuries. In partnership with individuals from the local construction industry, we developed a leading indicator-based program, also known as a safety communication and recognition program, B-SAFE (www.northeastern.edu/b-safe) (5). B-SAFE facilitates communication between workers and management regarding hazard controls as identified by safety inspections completed by in-house safety professionals. The program uses frequent (more than once per week) inspections that communicate positive safe working conditions (eg, recognizing the use of hazard controls). The B-SAFE program was designed to be an add-on to an existing health and safety program in which regular safety inspections are part of safety management system. However, the efficacy and effectiveness of the B-SAFE program on changing safety conditions and preventing injuries is unknown.
Author Manuscript
Our aim was to evaluate the efficacy of B-SAFE on measures of safety at the worksite through a cluster randomized controlled trial (RCT) using a mixed methods approach. We hypothesized that intervention sites would show a greater improvement over time than control sites, in both quantitative and qualitative measures of safety. Quantitatively, our primary outcome was safety climate. Based on the functional construct of organizational climate (6), safety climate is the workers’ perception of what is rewarded and supported at the worksite with regard to safety and its competing messages such as productivity (6, 7). Within the theoretical framework of this definition, we expected the B-SAFE program to improve safety climate as the program should increase communications and provides a reward for all workers when safety working conditions are achieved consistently on a site. In addition, safety climate may act as a proxy for injury outcomes based on its empirical associations of injury measures (7–11) and the theoretical safety performance framework of Neal and Griffin (12, 13). Qualitatively, we explored B-SAFE’s effect on the themes of safety awareness, safety communication, and collaborative competition (themes identified as positively impacted by B-SAFE during our pilot) (5).
Scand J Work Environ Health. Author manuscript; available in PMC 2016 July 18.
Sparer et al.
Page 3
Author Manuscript
Methods Study design and sample population
Author Manuscript
We conducted a cluster RCT on four pairs of commercial construction worksites. One pair was recruited from an owner and three pairs from general contractors in the greater Boston area. The clustering was completed at the general contractor/owner pair level as we assumed that the variability between sites of different general contractors/owners would be much larger than the variability of sites within a general contractor/owner. To be included in the study, sites had to be using the online data inspection management program Predictive Solutions (Industrial Scientific, Oakdale, PA, http://www.predictivesolutions.com/solutions/ SafetyNet/) as standard practice prior to study initiation. To be eligible for inclusion, a site had to operate for >4 months from study initiation and have ≥30 workers at any one time (no maximum level of workers required). The sites within each pair were randomly assigned a treatment status of either control or intervention. Treatment conditions The intervention worksites implemented the B-SAFE program for 4–6 months (table 1). The program’s primary components were: (i) weekly worksite safety inspections; (ii) weekly feedback and communication; and (iii) monthly recognition and reward.
Author Manuscript
The worksite safety inspections were conducted via site walkthroughs by a trained safety manager from either the general contractor or owner. The safety inspections provided weekly safety performance scores for the worksite and each subcontractor. Inspections were inclusive of all trades and tasks on-site and included both the safe (control measures) and unsafe (hazards) physical working conditions and practices. Although each site had a different inspector, all followed the same guidelines. The inspector entered all data into Predictive Solutions and denoted each observation by subcontractor. Once per week, investigators downloaded the inspection data and generated a weighted safety performance score (the percent of safe observations out of the total observations) for the overall site, and for the individual subcontractor companies (5, 14).
Author Manuscript
The weekly feedback and communication consisted of worksite posters and detailed reports distributed to each subcontractor on safety observations at the weekly foremen meetings. The research team distributed subcontractor-specific reports to the foremen that detailed all observations, both safe and unsafe, from the previous week. Large posters located in high visibility areas displayed a graph of the overall site safety performance score along with an adjacent list of the subcontractors’ recent scores. The poster contained an inspection score goal that ranged from 94.8–96.3% depending on the site. This goal was determined in a previous analysis by Sparer and Dennerlein (14) in which various methods were evaluated to best determine thresholds in leading indicator-based safety inspection programs. The final threshold goal utilized was determined to be fair, consistent, attainable, and competitive. The goal was the median of monthly safety performance scores over the previous 12 months from sites of similar size and scope from either the site owner or general contractor’s (based on how the pair was selected) inspection history (14).
Scand J Work Environ Health. Author manuscript; available in PMC 2016 July 18.
Sparer et al.
Page 4
Author Manuscript
The monthly recognition depended upon the overall site score for that given month. If the score exceeded the calculated goal, the whole site was recognized for their strong safety record with a catered lunch and participation in a raffle for either a one-month parking pass at a location near the worksite or a gas station gift certificate. If the score was below the goal, the research team conveyed this information to workers during foremen’s meetings and other whole site gatherings (such as stretch-and-flex). The control sites consisted of the contractors’ standard safety programs along with a few posters with the B-SAFE logo only. Given the rigor of the data collection methods and high frequency of site visits required to do so, research team members were on both site types almost daily, leading to a strong presence at both. Intervention efficacy evaluation
Author Manuscript
We used a mixture of quantitative and qualitative methods to evaluate the efficacy of BSAFE. We considered this study an efficacy evaluation as it was conducted by study investigators in an environment in which the intervention and control conditions were highly standardized between sites (15). Worker surveys were completed pre- and post-exposure to the treatment and served to quantitatively assess changes in the study’s primary outcome of safety climate (figure 1). Due to limited time for survey data collection at the 10–15 minute coffee breaks, we used qualitative methods to assess all other constructs from figure 1 in a subset of workers. Quantitative data collection
Author Manuscript
We invited workers on all sites to complete a pre-exposure survey at one of two times. For workers already on-site at study initiation, we invited workers at a study kick off meeting. For workers who started after the study began, we invited them during new worker safety orientations held multiple times per week. These orientations were mandatory and led by the general contractor. After collecting all completed surveys at intervention sites, we gave a 5– 10 minute oral presentation that described the B-SAFE program. At control sites, workers were simply told that B-SAFE was a study of worksite safety and researchers would be onsite regularly to collect surveys. Workers aged 18–65 who could read and write English were eligible for the survey. We collected and compared names from survey respondents to track workers moving between sites.
Author Manuscript
We invited workers still on-site to complete post-exposure surveys every 30 days following their pre-exposure survey. We used a mixture of text messages and communication with onsite foremen and management to determine if a worker was still on the study site for the monthly follow up survey (16). When we initiated the study in 2010, we made the decision to use a safety climate questionnaire developed by Dedobbeleer and Béland for use within the construction industry (17) given the importance of using an industry-specific scale to describe the safety climate (18) (Appendix A, www.sjweh.fi/index.php?page=data-repository). The questions were indirectly based on Zohar’s original 40-item and 8-factor scale (6, 17, 19). Gillen et al (20) used the Dedobbeleer and Béland items as a single factor to measure safety climate within a
Scand J Work Environ Health. Author manuscript; available in PMC 2016 July 18.
Sparer et al.
Page 5
Author Manuscript
cohort of construction workers and found a positive association between safety climate and injury severity. We modified the Dedobbeleer and Béland safety climate items in two ways. First, we modified the responses of the questions to reflect a Likert scale response. Second, based on inspection of the nine items, it became apparent that some items appeared to represent safety performance constructs such as safety training (items 6–7) and risk perception (items 8–9) rather than safety climate. Therefore, we performed an exploratory factor analysis using principal component analysis to assess the internal validity of the scale.
Author Manuscript
Factor analysis of the 9-item baseline data indicated that the items grouped together in two factors, a 7-item (scale items 1–7) and a 2-item (scale items 8–9). However, 2 of the 7 items (6–7) had factor loadings that were very weak (30 days. The conclusions therefore may not be reflective of all workers and may exhibit a form of selection bias. The workers who are on-site >30 days are different in their distribution of trade, job title, race/ethnicity, and baseline musculoskeletal pain than workers who are on-site
Scand J Work Environ Health. Author manuscript; available in PMC 2016 July 18. Published in final edited form as: Scand J Work Environ Health. 2016 July 1; 42(4): 329–337. doi:10.5271/sjweh.3569.
Improving safety climate through a communication and recognition program for construction: a mixed-methods study Emily H Sparer, ScD1,2, Paul J Catalano, ScD3,4, Robert F Herrick, ScD1, and Jack T Dennerlein, PhD1,5 1Department
of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA,
USA
Author Manuscript
2Department
of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
3Department
of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
4Department
of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston,
MA, USA 5Department
of Physical Therapy, Movement, and Rehabilitation Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
Abstract Author Manuscript
Objectives—This study aimed to evaluate the efficacy of a safety communication and recognition program (B-SAFE), designed to encourage improvement of physical working conditions and hazard reduction in construction. Methods—A matched pair cluster randomized controlled trial was conducted on eight worksites (four received the B-SAFE intervention, four served as control sites) for approximately five months per site. Pre- and post-exposure worker surveys were collected at all sites (N=615, pre-exposure response rate of 74%, post-exposure response rate of 88%). Multi-level mixed-effect regression models evaluated the effect of B-SAFE on safety climate as assessed from surveys. Focus groups (N=6–8 workers/site) were conducted following data collection. Transcripts were coded and analyzed for thematic content using Atlas.ti (version 6).
Author Manuscript
Results—The mean safety climate score at intervention sites, as measured on a 0–50 point scale, increased 0.5 points (1%) between pre- and post-B-SAFE exposure, compared to control sites that decreased 0.8 points (1.6%). The intervention effect size was 1.64 (3.28%) (Pvalue=0.01) when adjusted for month the worker started on-site, total length of time on-site, as well as individual characteristics (trade, title, age, and race/ethnicity). At intervention sites, workers noted increased levels of safety awareness, communication, and teamwork compared to control sites.
Correspondence to: Jack Dennerlein, Department of Physical Therapy, Movement, and Rehabilitation Sciences, Bouvé College of Health Sciences, Northeastern University, 301 Robinson Hall, 360 Huntington Ave, Boston, MA 02115, USA. [email protected].
Sparer et al.
Page 2
Author Manuscript
Conclusions—B-SAFE led to many positive changes, including an improvement in safety climate, awareness, teambuilding, and communication. B-SAFE was a simple intervention that engaged workers through effective communication infrastructures and had a significant, positive effect on worksite safety. Keywords B-SAFE; communication; construction; construction industry; construction worker; hazard control; health and safety; mixed method; mixed-method study; recognition; safety; safety climate; safety incentive program; safety intervention
Author Manuscript
Recent decades have brought large improvements to health and safety conditions in the construction industry, yet the number of fatal and non-fatal injuries remains extremely high (1). To combat this, some employers have implemented safety incentive programs, such as those that use injury-based safety performance metrics to evaluate overall worksite safety and reward workers. However, these lagging indicator-based programs may discriminate against injured workers (2) and may reduce injury reporting (3, 4).
Author Manuscript
As an alternative, programs could rely instead on leading indicators of safety, such as hazard control and other root causes of injuries. In partnership with individuals from the local construction industry, we developed a leading indicator-based program, also known as a safety communication and recognition program, B-SAFE (www.northeastern.edu/b-safe) (5). B-SAFE facilitates communication between workers and management regarding hazard controls as identified by safety inspections completed by in-house safety professionals. The program uses frequent (more than once per week) inspections that communicate positive safe working conditions (eg, recognizing the use of hazard controls). The B-SAFE program was designed to be an add-on to an existing health and safety program in which regular safety inspections are part of safety management system. However, the efficacy and effectiveness of the B-SAFE program on changing safety conditions and preventing injuries is unknown.
Author Manuscript
Our aim was to evaluate the efficacy of B-SAFE on measures of safety at the worksite through a cluster randomized controlled trial (RCT) using a mixed methods approach. We hypothesized that intervention sites would show a greater improvement over time than control sites, in both quantitative and qualitative measures of safety. Quantitatively, our primary outcome was safety climate. Based on the functional construct of organizational climate (6), safety climate is the workers’ perception of what is rewarded and supported at the worksite with regard to safety and its competing messages such as productivity (6, 7). Within the theoretical framework of this definition, we expected the B-SAFE program to improve safety climate as the program should increase communications and provides a reward for all workers when safety working conditions are achieved consistently on a site. In addition, safety climate may act as a proxy for injury outcomes based on its empirical associations of injury measures (7–11) and the theoretical safety performance framework of Neal and Griffin (12, 13). Qualitatively, we explored B-SAFE’s effect on the themes of safety awareness, safety communication, and collaborative competition (themes identified as positively impacted by B-SAFE during our pilot) (5).
Scand J Work Environ Health. Author manuscript; available in PMC 2016 July 18.
Sparer et al.
Page 3
Author Manuscript
Methods Study design and sample population
Author Manuscript
We conducted a cluster RCT on four pairs of commercial construction worksites. One pair was recruited from an owner and three pairs from general contractors in the greater Boston area. The clustering was completed at the general contractor/owner pair level as we assumed that the variability between sites of different general contractors/owners would be much larger than the variability of sites within a general contractor/owner. To be included in the study, sites had to be using the online data inspection management program Predictive Solutions (Industrial Scientific, Oakdale, PA, http://www.predictivesolutions.com/solutions/ SafetyNet/) as standard practice prior to study initiation. To be eligible for inclusion, a site had to operate for >4 months from study initiation and have ≥30 workers at any one time (no maximum level of workers required). The sites within each pair were randomly assigned a treatment status of either control or intervention. Treatment conditions The intervention worksites implemented the B-SAFE program for 4–6 months (table 1). The program’s primary components were: (i) weekly worksite safety inspections; (ii) weekly feedback and communication; and (iii) monthly recognition and reward.
Author Manuscript
The worksite safety inspections were conducted via site walkthroughs by a trained safety manager from either the general contractor or owner. The safety inspections provided weekly safety performance scores for the worksite and each subcontractor. Inspections were inclusive of all trades and tasks on-site and included both the safe (control measures) and unsafe (hazards) physical working conditions and practices. Although each site had a different inspector, all followed the same guidelines. The inspector entered all data into Predictive Solutions and denoted each observation by subcontractor. Once per week, investigators downloaded the inspection data and generated a weighted safety performance score (the percent of safe observations out of the total observations) for the overall site, and for the individual subcontractor companies (5, 14).
Author Manuscript
The weekly feedback and communication consisted of worksite posters and detailed reports distributed to each subcontractor on safety observations at the weekly foremen meetings. The research team distributed subcontractor-specific reports to the foremen that detailed all observations, both safe and unsafe, from the previous week. Large posters located in high visibility areas displayed a graph of the overall site safety performance score along with an adjacent list of the subcontractors’ recent scores. The poster contained an inspection score goal that ranged from 94.8–96.3% depending on the site. This goal was determined in a previous analysis by Sparer and Dennerlein (14) in which various methods were evaluated to best determine thresholds in leading indicator-based safety inspection programs. The final threshold goal utilized was determined to be fair, consistent, attainable, and competitive. The goal was the median of monthly safety performance scores over the previous 12 months from sites of similar size and scope from either the site owner or general contractor’s (based on how the pair was selected) inspection history (14).
Scand J Work Environ Health. Author manuscript; available in PMC 2016 July 18.
Sparer et al.
Page 4
Author Manuscript
The monthly recognition depended upon the overall site score for that given month. If the score exceeded the calculated goal, the whole site was recognized for their strong safety record with a catered lunch and participation in a raffle for either a one-month parking pass at a location near the worksite or a gas station gift certificate. If the score was below the goal, the research team conveyed this information to workers during foremen’s meetings and other whole site gatherings (such as stretch-and-flex). The control sites consisted of the contractors’ standard safety programs along with a few posters with the B-SAFE logo only. Given the rigor of the data collection methods and high frequency of site visits required to do so, research team members were on both site types almost daily, leading to a strong presence at both. Intervention efficacy evaluation
Author Manuscript
We used a mixture of quantitative and qualitative methods to evaluate the efficacy of BSAFE. We considered this study an efficacy evaluation as it was conducted by study investigators in an environment in which the intervention and control conditions were highly standardized between sites (15). Worker surveys were completed pre- and post-exposure to the treatment and served to quantitatively assess changes in the study’s primary outcome of safety climate (figure 1). Due to limited time for survey data collection at the 10–15 minute coffee breaks, we used qualitative methods to assess all other constructs from figure 1 in a subset of workers. Quantitative data collection
Author Manuscript
We invited workers on all sites to complete a pre-exposure survey at one of two times. For workers already on-site at study initiation, we invited workers at a study kick off meeting. For workers who started after the study began, we invited them during new worker safety orientations held multiple times per week. These orientations were mandatory and led by the general contractor. After collecting all completed surveys at intervention sites, we gave a 5– 10 minute oral presentation that described the B-SAFE program. At control sites, workers were simply told that B-SAFE was a study of worksite safety and researchers would be onsite regularly to collect surveys. Workers aged 18–65 who could read and write English were eligible for the survey. We collected and compared names from survey respondents to track workers moving between sites.
Author Manuscript
We invited workers still on-site to complete post-exposure surveys every 30 days following their pre-exposure survey. We used a mixture of text messages and communication with onsite foremen and management to determine if a worker was still on the study site for the monthly follow up survey (16). When we initiated the study in 2010, we made the decision to use a safety climate questionnaire developed by Dedobbeleer and Béland for use within the construction industry (17) given the importance of using an industry-specific scale to describe the safety climate (18) (Appendix A, www.sjweh.fi/index.php?page=data-repository). The questions were indirectly based on Zohar’s original 40-item and 8-factor scale (6, 17, 19). Gillen et al (20) used the Dedobbeleer and Béland items as a single factor to measure safety climate within a
Scand J Work Environ Health. Author manuscript; available in PMC 2016 July 18.
Sparer et al.
Page 5
Author Manuscript
cohort of construction workers and found a positive association between safety climate and injury severity. We modified the Dedobbeleer and Béland safety climate items in two ways. First, we modified the responses of the questions to reflect a Likert scale response. Second, based on inspection of the nine items, it became apparent that some items appeared to represent safety performance constructs such as safety training (items 6–7) and risk perception (items 8–9) rather than safety climate. Therefore, we performed an exploratory factor analysis using principal component analysis to assess the internal validity of the scale.
Author Manuscript
Factor analysis of the 9-item baseline data indicated that the items grouped together in two factors, a 7-item (scale items 1–7) and a 2-item (scale items 8–9). However, 2 of the 7 items (6–7) had factor loadings that were very weak (30 days. The conclusions therefore may not be reflective of all workers and may exhibit a form of selection bias. The workers who are on-site >30 days are different in their distribution of trade, job title, race/ethnicity, and baseline musculoskeletal pain than workers who are on-site
